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OCR for page 156
Appendix C
Summit Strategies and Actions
The following summarizes proposed strategies developed by participants at the Institute of
Medicine's Health Professions Education Summit held in June 2002 to integrate the core set of
competencies set forth in this report into health professions education. These strategies address
distinct but overlapping groups—oversight experts, health care academic and practice leaders, health
professions faculty, and researchers and apply to all disciplines. The committee reviewed the ideas
that emerged from the seven interdisciplinary groups at the summit and identified the following five
cross-cutting strategies:
· Define a common language and core competencies across the professions.
· Integrate the core competencies into oversight processes (accreditation, licensing, and
certification).
· Motivate and support leaders, and monitor the progress of the overall reform effort.
· Develop evidence-based curricula and teaching approaches as they relate to the core set of
competencies.
· Develop faculty as teaching/learning experts in the core set of competencies.
The committee carefully considered the ideas generated by the 150 expert participants at the
summit in developing this follow-up report and its recommendations.
156
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APPENDIX C
B ,
The following sections present an overarching vision developed by the committee for each of
these proposed strategies and a specific articulation of the strategy by individuals in the respective
summit group. Actions are also presented, most at the national level, that represent ways the
strategies could be implemented by one or more participants in each group. Finally, select
institutional-level actions, developed by individuals from the listed organizations are included for
illustrative purposes.
157
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HEALTH PROFESSIONS EDUCATION
DEVELOP A COMMON LANGUAGE AND CORE COMPETENCIES
Vision
Across hea1/tth professions schools andpractice environments, there is a shared
definition of key terms and competencies for educating health care professiona1/ts.
Whi1/te the ro1/tes of individua1/t health professiona1/ts vary with respect to each of the
competencies, these shared def nitions transcend occupations and enab1/te cross-
discip1/tinary communication. They enable interdiscip1/tinary groups to define and reach
consensus around a core set o, f competencies, for health pro, Cessions education.
Proposed Strategy
The health professions should collectively take deliberate steps to build consensus around common
terms and competencies.
Proposed Actions
· Initiate a formal process, involving a broad cross section of disciplines, to identify areas of
agreement and those that are sensitive or taboo. Also, identify how terms are used in the
literature, oversight processes, law, and policy. Write a paper identifying related issues.
.
Engage key stakeholder professions in understanding the problems and related issues
associated with the lack of a common language.
· Create an interdisciplinary group to develop a common language.
· Define commonalities with respect to competencies across professions, and capture in a
report.
158
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APPENDIX C
The common language and common competency working group
included representation from:
· Alliance for Continuing Medical
Education
· American Nurses Association, Division
of Nursing
· Case Western Reserve University,
School of Nursing
· Colorado Chapter of the Federation of
Families for Children's Mental Health
East Central University
· Grace Episcopal Church
.
Health Resources and Services
Administration, Office of Rural Health
Policy
· Intermountain Health Care Inc., Clinical
Support Services
· The Johns Hopkins University Hospital,
Nurse Administration, GYN/OB
· Mayo Clinics Department of Nursing
· National Network of Health Career
Programs in Two-Year Colleges
· University of Missouri-Columbia,
School of Health Professions
.
Selected Institutional Actions
University of Texas, M.D. Anderson
Cancer Center, Nursing Practice and
Policy
Yale University, Managed Behavioral
Health Care, Department of Psychiatry
· Contact National Board for Certification in Occupational Therapy (NBCOT) to brief them
on summit objectives and discuss possible future role
University of Texas, M.D. Anderson Cancer Center contact office of nursing services for
nominees for group focused on developing common language and survey Texas Medical
Center leadership for how to link this effort to professional partnership project.
· Alliance for Continuing Medical Education, Colorado Chapter of the Federation of Families
for Children's Mental Health, National Network of Health Career Programs in Two Year
Colleges, create a list of individuals to participate on the interdisciplinary team charged with
developing common competencies.
159
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HEALTH PROFESSIONS EDUCATION
INTEGRATE CORE COMPETENCIES INTO OVERSIGHT PROCESSES
Vision
There is consistency in approach and coordination across the various hea1/tth
professions oversight organizations inc1/~ding accrediting, 1/licensing and
certification bodies as the resu1/tt of a focus on an agreed-upon set of core
competencies. This consistency a1/~1/tows for enhanced communication, integration, and
synergy within and across oversight bodies andprofessions. As a resu1/tt, educationa1/t
programs are eva1/~uated based on outcomes, and a c1/tinician's competency is assessed
upon entry into practice and regu1/lar1/ly throughout his or her career.
-
Proposed Strategy
The TOM should convene accreditation, licensing, and credentialing organizations across the
spectrum of health professions to move all health professions to competency-based oversight that
incorporates the five core competencies.
Proposed Actions
· Establish communication links among regulators.
· Define accreditation standards and measurements for the core competencies. Share best
practices across professions.
· Request the addition of the competencies to licensing exams.
· Develop model oversight processes related to the competencies.
The oversight process working group included representatives from:
· AcademyHealth
· Accreditation Council for Continuing
Medical Education
160
· Accreditation Council for Graduate
Medical Education
· Alliance of Community Health Plans
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APPENDIX C
· American Association of Colleges of
Nursing
· American Board of Internal Medicine
American College of Clinical Pharmacy
· American Council on Pharmaceutical
Education
American Osteopathic Association
Association of American Medical
Colleges, Educational Standards
Baton Rouge General Medical Center,
Family Medicine Residency Program
Baystate Medical Center
Center for Clinical Improvement,
Vanderbilt University
Charles R. Drew University of
Medicine-Los Angeles, Dean's Office/
Academic Affairs
Citizen Advocacy Center
Commission on Accreditation of Allied
Health Education
Federation of State Medical Boards of
the United States, Inc.
The George Washington University,
Department of Health Policy
· Harvard School of Public Health
· Holy Cross Hospital, Continuing
Medical Education
· Joint Commission on Accreditation of
Healthcare Organizations
.
National Association of Boards of
Pharmacy, Washington State Board of
Pharmacy
· National Board of Medical Examiners
· National Council of State Boards of
Nursing
· National Institute for Standards in
Pharmacist Credentialing
.
National Organization for Associate
Degree Nursing
· National Organization of Nurse
Practitioner Faculties
· North Carolina Board of Nursing
· People's Medical Society
· School of Nursing, Vanderbilt
University
· The Robert Wood Johnson Foundation,
Communications DepaWnent
.
Donald W. Reynolds Department of
Geriatrics, University of Arkansas
Medical Sciences
· University of Washington, MEDEX
Selected Institutional Actions
· Develop National Council of State Boards of Nursing model regulations for quality
improvement competencies.
Work on developing and defining standards for quality improvement for practicing
pediatricians as part of maintenance of certification at the American Board of Pediatrics.
· Request the addition of informatics competencies to the pharmacy licensing exam by the
National Association of Boards of Pharmacy.
· Joint Commission on Accreditation of Healthcare Organizations advocate and participate in
a meeting of regulators across the health professions.
Federation of State Medical Boards work with the National Board of Medical Examiners to
incorporate patient-centered care skills into the United States Medical Licensing Exam.
161
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HEALTH PROFESSIONS EDUCATION
Motivate And Support Leaders And Monitor Progress Of Reform Effort
Vision
An interdiscip1/tinary group of education 1/leaders from practice environments and
academic and continuing education settings, and inc1/~ding students works to create
a shared mission and vision for hea1/tth professions education that re1/lates to but is
1/larger than the five competencies. This reform-minded group monitors progress
made on integrating the competencies into hea1/tth professions education andprovides
a regu1/lar status report to the 1/larger education and qua1/tity communities. The group
a1/tso supports 1/leadership training for education 1/leaders, recognizes and rewards
1/leaders who make a significant contribution to educationa1/t reform, and continuously
assesses changing ski1/~1/t needs for hea1/tth professiona1/ts.
1=_
Proposed Strategies
~ - a—
= ~
The TOM should convene a council of national educational leaders in academic and practice settings,
as well as leading consumer advocacy organizations, to develop a joint agenda related to leadership
and the overarching vision of a prepared health professional, and to monitor progress against this
. .
vlslon.
The health professions should collectively identify funds that can be used to foster and support
partnerships between education and practice leaders with regard to the overarching vision of a
prepared health professional.
Proposed Actions
Develop and make use of fact sheets and case studies that make the case for the overarching
vision and the need for reform of health professions education.
Promote the overarching vision to the leadership of key organizations.
Monitor, evaluate, and communicate progress against this vision by examining efforts to
integrate the core competencies into health professions education, including the extent to
which summit participants fulfill their commitments.
Make the case to sponsors for funding of the council, leadership development activities, and
partnerships between academic and practice leaders.
162
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APPENDIX C
| . Create and support leadership development skills programs, including efforts to link
academic and practice leaders.
· Create and fund fellowships for formal leadership courses.
· Charge the IOM to create a national award related to implementation of the overarching
. .
vlslon.
The leadership and monitoring progress
working group included representation from:
· American Nurses Association · The Johns Hopkins University
· American Board of Internal Medicine · Kaiser Permanente
Foundation · Kansas University School of Nursing
· American Organization of Nurse · Massachusetts General Hospital
Executives
· National Association of Community
· American Pharmaceutical Association Health Centers
· American Psychological Association · National Association of Hispanic Nurses
· Association of Academic Health Centers · National Center for Healthcare
· Association of Schools of Allied Health Leadership
Professions . The Robert Wood Johnson Foundation,
· Center for Innovation in Public Mental Executive Nurse Fellows Program
Health, University of South Carolina · National Committee for Quality
· College of Nursing, University of Iowa Assurance
. Continuing Medical Education, . School of Nursing, Duke University
Greensb 0 ro Area Health Education · Sch 0 ol 0 f Nursing, Oregon Health
Center Sciences University
· Department of Family and Preventive · School of Nursing, University of
Medicine, University of Utah School of Michigan
Medicine
· St Cloud State University
· Department of Nursing and Patient
Services, Shands Hospital at the · University of Rochester, School of
University of Florida Medicine and Dentistry
· Department of Veterans Affairs, · University of Wisconsin Hospital and
Veterans Health Administration Clinics, University of Wisconsin
Medical School
· Drugay and Associates
· Vanderbilt Medical Center
· General Electric Co.
· Virginia Commonwealth University
· Grantmakers in Health
· Wake Area Health Education Center,
· Healthcare Education Industry University of North Carolina Chapter
Partnership, Minnesota State Colleges
and Universities
· John A. Hartford Foundation
163
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HEALTH PROFESSIONS EDUCATION
Selected Institutional Actions
.
National Association of Community Health Centers provide leadership development related
to integrating the summit vision of health professions education into community health cen-
ter boards.
National Center for Healthcare Leadership revise graduate and continuing education curric-
ula to be consistent with the vision in the Quality Chasm report (Institute of Medicine,
2001).
· Implement new skills in experiential learning and in continuing education for pharmacists at
the Area Health Education Center in Wake, North Carolina.
· Minnesota Healthcare Education Industry Partnership convene a working group on imple-
mentation of the overarching summit vision.
Create a coalition of all five University of Iowa health science deans, chief executive offi-
cers of hospitals and hygienic laboratories, and provosts to develop state-level legislative
strategies to support the summit's overarching vision.
164
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APPENDIX C
Develop Evidence-Based Curricula And Teaching Approaches
Vision
A rich, readi1/ly avai1/lab1/te evidence base exists to make the case for teaching the five
competencies to hea1/tth professions students and c1/tinicians, demonstrating the strong
re1/lationship between these competencies and enhanced qua1/tity outcomes for patients.
This evidence base is integrated across ad the hea1/tth professions through 1/linkages to
profession-specific databases. In addition, those who instruct and mentor hea1/tth
professiona1/ts in both academic and continuing education settings have access to a
we/ -deve1/toped evidence base regarding the effectiveness of teaching methods and a
continuously updated best-practices database.
i `;;;65; :~135s ' Add 34` DISC,``
Proposed Strategies
Educate health professional groups to focus on the link between health professions education and
quality.
Activate health professional groups to create and fund a new organization whose research efforts are
focused on evidence-based education and the five competencies.
Proposed Actions
· Promote the link between education and quality within leading health professional
organizations.
· Key medical organizations focus on this link as an important issue; begin by writing an
editorial to make the case.
Association of Academic Health Centers or National Academies of Practice bring health
educational professionals together to address the redesign of education, specifically
organizational structures.
Ask the National Quality Forum to examine the relationship between education and quality.
Strengthen the focus of fellowships on the overarching vision defined by the TOM
committee.
165
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HEALTH PROFESSIONS EDUCATION
| . Investigate/identify information systems that support evidence-based education.
· Establish an Interdisciplinary Health Professional Education organization, supported by key
stakeholders, to identify and evaluate education models that further the overarching vision,
function as a repository of related data, and disseminate best practices. This organization
should:
- Demonstrate the importance of education by focusing on compelling examples in which
educational interventions have made a difference to patient outcomes (e.g., wrong-side
surgeries, diabetes).
- Perform a systematic review of the literature (e.g., best evidence in medical education or
best-evidence medical practice, and determine a future research agenda, looking to the
Agency for Healthcare Research and Quality.
- Conduct a best-practice review of universities that have integrated the five competencies
into their curricula to understand what they do and how/why it is a best practice.
- Create a database of best practices in health professions education.
- Develop research coliaboratives among institutions to demonstrate the effectiveness of the
five competencies in both academic and continuing education settings.
- Assess the interest among the leadership of the American Academy of Family Physicians in
hosting a symposium as part of the research agenda-setting process.
The evidence base and curricula development
working groups included representation from:
· ABIM Foundation · Health Resources and Services
Administration, Division of Medicine
· AcademyHealth
and Dentistry, Bureau of Health
· American College of Healthcare Professions
Executives · New Jersey Medical School, University
· American College of Physicians of Medicine and Dentistry of New
. . . . Jersey, Division of Adolescent and
· American Hospital Association . .
Young Adult Medicine
· American Society of Internal Medicine
· North American Assoc~ahon of Medical
· Cedars Sinai Medical Center Education and Communication
· Community College of Philadelphia, Companies
Department of Nursing · Nurse Practitioner Faculty
· Council on Graduate Education · Oregon Health and Science University,
School of Medicine
· Brighton University, Office of
Interprofessional Education · The Robert Graham Center: Policy
· Florida State University, College of Studies in Family Practice and Primary
Medicine Care
166
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APPENDIX C
· University of Arizona, Arizona Health
Sciences Center, College of Pharmacy
University of Iowa, College of Nursing
· University of Maryland, Department of
Medical and Research Technology,
School of Medicine
.
University of Massachusetts, School of
Nursing
· University of Missouri, School of
Medicine
· Veterans Health Administration,
Department of Veterans Affairs
· Veterans Health Administration,
National Center for Patient Safety
Selected Institutional Actions
· For the American College of Physicians, American Society of Internal Medicine, project on
Training for Quality and Evidence Base, stimulate and write educational articles for
publication in Annals of Internal Medicine.
.
North American Association of Medical Education and Communication Companies
(NAMMEC), with support from the NAAMEC Board, develop a research project proposal
focused on creating a model for evaluating the effectiveness of continuing medical
education, carry out the project, and then disseminate results at meetings and in
publications.
· Robert (Jraham (:enter: Policy Studies in Family Practice and Primary Care approach the
Agency for Healthcare Research and Quality, the National Science Foundation, Health
Resources and Services Administration, and foundations about sponsoring a symposium to
develop a research focus on interdisciplinary education.
Creighton University, Office of Interprofessional Education, design and conduct an
interdisciplinary collaborative research project on effective evaluation of interprofessional
education.
Texas Tech University Health Sciences Center, School of Nursing, identify specific content
for an interdisciplinary curriculum through a survey of faculty in various professions at
Texas Tech.
Center for Health Policy and Workforce Research, Towson University, hold a follow-up
meeting with Towson University leadership to identify resources and plan the development
of new centers and cross-professional activities.
University of Alabama at Birmingham (UAB), School of Health Related Professions, create
a center or office for health professions education and workforce development at UAB.
· Samford University, McWhorter School of Pharmacy, distribute a "Samford
Plan" (continuous quality improvement process model for curriculum development and
refinement) to all summit participants.
167
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HEALTH PROFESSIONS EDUCATION
Develop Faculty As Teaching And Learning Experts
Vision
Facu1/tty deve1/topment programs exist at the nationa1/t and regiona1/t 1/teve1/ts for the array
of hea1/tth professional/ educators, focused on the overarching vision presented in this
report. The programs, many of which are interdliscip11tinary, prepare faculty to convey
the five competencies, as we1/~1/t as to adopt an evidence-based approach to education.
~_~
Proposed Strategy
Health professional groups should motivate and enable faculty in their efforts to implement the
overarching vision of a prepared health professional.
Proposed Actions
· Identify cross-cutting faculty competencies.
Ilelp organize an inventory of best practices and resources for faculty development.
Create a program to recognize "educational scholars" on a national basis, and promote the
program to health professional schools.
· Develop and disseminate online self-instructional lessons/courses in faculty development
related to the overarching vision.
Help develop models for reform of criteria for promotion and related compensation,
including tenure models, starting initially in the field of pharmacy.
The faculty development working group included representation from:
American Association of Colleges of
Pharmacy
· Community College of Philadelphia,
Department of Nursing
Health Resources and Services
Administration
· Michigan State University
· National League for Nursing
New York University, School of Medicine
.
Southern Regional Education Board,
Council on Collegiate Education for
Nursing
University of Colorado Health Sciences
Center, Office of Education
· University of Washington, School of
Medicine
· Virginia Commonwealth University,
School of Nursing
168
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APPENDIX C
Selected Institutional Actions
School of Medicine, New York University, assess existing quality improvement processes
for education as part of an effort to achieve consensus on a quality improvement model for
all of health professions education.
· Council on Collegiate Education for Nursing, Southern Regional Education Board (SREB),
conduct a validation study of expected competencies for nurse educators in 16 SREB states.
· American Association of Colleges of Pharmacy help organize an effort to inventory best
practices and resources for faculty development.
· Virginia Commonwealth University provide information technology orientation for new
faculty.
· Michigan State University work with a national professional training organization and the
Association of Program Directors in Internal Medicine to begin to develop online self-
instruction in faculty development.
169
Representative terms from entire chapter:
professions education
